Dr. Robert Morton is not afraid of a challenge, which is why he helped start the inpatient behavioral health program for patients with intellectual and developmental disabilities (IDD) at Mercy Hospital Ada in 2008.
“It’s a population that’s difficult to treat because they have so many cognitive and functional issues, which cause some pretty significant behavioral issues at times,” said Morton, a board-certified internist and psychiatrist.
Morton serves as the medical director of the behavioral health unit at Mercy Hospital Ada and Rolling Hills Hospital, also in Ada.
The two IDD inpatient programs at Mercy Hospital Ada and Rolling Hills Hospital are among only a handful of similar programs across the country, making Ada a leader in the delivery of mental health services to patients with conditions like autism, Down’s syndrome and other intellectual and developmental disabilities.
Patients come to Ada from every county in Oklahoma, and many states, including Kansas, Texas, Arkansas, Louisiana, Missouri, Iowa, Tennessee, New Mexico, Minnesota and Michigan, said Morton.
“The cognitive level of IDD patients can often be childlike,” said Debbie Forster, administrative director of the behavioral health unit at Mercy Hospital Ada. “If a behavioral health program geared toward a typical adult patient doesn’t specialize in treating someone with developmental disabilities, then those patients with limited cognitive function can’t adequately utilize the therapeutic interventions in those programs that are necessary for their recovery and to function in their specialized living situations.”
Help for an Undertreated Group
Many of the IDD patients who stay in the behavioral health unit at Mercy also have significant mental illnesses, including bi-polar disorder, depression, schizophrenia, impulse control disorder, intermittent explosive disorder (involves aggression and violence), pica (where patients eat anything they encounter) and other conditions. The program is geared toward patients ages 18 and up.
Often, these mental illnesses are either undiagnosed or not treated with the right medications. Mercy’s behavioral health unit features 10 designated beds to treat IDD patients.
“A lot of their mental health issues — hearing voices, staying up all night, mania, depression, self-injurious behaviors — have in the past been written off as being part of their intellectual disability,” said Morton. “When we get them on the medications to address the underlying mental illness, their life changes.”
Morton and the staff in the behavioral health unit at Mercy have witnessed many of those life changes.
Brenda Bause, a staff therapist in the behavioral health unit at Mercy, said patients often come in because of aggressive and disruptive behaviors. They work with these patients through individual and group counseling sessions, and by adjusting their medications, which helps stabilize their mood and correct many of the behaviors.
“They’re able to cope better and have a great reduction in aggression or agitation,” she said. “They can usually go back home or to a group home and be much more successful.”
The nursing staff works with patients on daily living skills, including hand hygiene, brushing their teeth or taking a shower with minimal assistance.
When patients leave the program, Morton often follows up with them at their group home or in his office. He also stays in contact with other patients’ caregivers who are not connected to the facilities he travels to.
“We try to maintain long-term contact with everyone,” said Morton. “For this population, it’s always a balance between the right kind of environment and the right kind of medication to give the optimal effect. It’s so crucial to allow these individuals to have a sense of some control over their lives because so much of it is controlled for them.”
For Morton, success comes when a patient is able to go on a shopping trip to Walmart, bowling or to a dance because they are no longer participating in harmful or dangerous behaviors like cutting themselves, picking at their skin, banging their head against the wall or threatening peers and staff with violence and aggression.
“It’s a population that’s vastly undertreated because they’re hard to treat and require a lot of time and patience, but they get better,” said Morton. "It is a privilege for all of us at Mercy to treat this very special population with special needs who have wonderful personalities and much to give to our society."
Without these specialized IDD programs, Kerrie Roberson believes many of these patients may harm themselves or others, and may even end up in jail.
“The need is great,” said Roberson, nurse manager for Mercy’s behavioral health unit. “We generally have a waiting list. Lots of patients get treated on an outpatient basis, but I feel like they would do better here. There is great need around the country for other units that are designed like we are.”
Care for the Aging Population
In addition to 10 beds for IDD patients, the behavioral health unit at Mercy also offers 10 inpatient beds for geriatric patients (ages 65 and up). Many of these patients suffer from conditions like Alzheimer’s disease and other dementias with decreased levels of physical activity, depression, delirium and psychosis (a loss of reality).
Typically, when geriatric patients are admitted to the inpatient unit at Mercy, they are physically or verbally aggressive with others, or may have trouble controlling their impulses. They become very uninhibited in their behaviors and may, for example, curse or threaten family members when they have had no previous history of such behaviors.
Although geriatric inpatient services are commonly offered in behavioral health units across the country, these services are becoming more necessary as the Baby Boomer generation continues to live longer.
“We don’t necessarily extend life since there’s no cure for conditions like Alzheimer’s disease, but we can improve the quality of life,” said Morton. “A patient can be calmer and not as easily provoked when they’re on the right medication. They can sleep better and even, to some degree, their memory can improve for a period of time.”
Making a Difference
In some cases, Bause said the interventions (therapy and medication management) might help geriatric and IDD patients return to their family home rather than a nursing home or group home, which is a big victory.
“I enjoy seeing people in a lot of distress and discomfort become calmer and better able to deal with day-to-day life,” she said.
To learn more about the inpatient behavioral health programs at Mercy Hospital Ada, call 580-421-1234 or visit www.mercy.net/practice/mercy-behavioral-health-ada.